327 - Guardian Presence in Children Evaluated in the Emergency Department for Blunt Abdominal Trauma
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 327 Publication Number: 327.208
Irma Ugalde, McGovern Medical School at UTHealth Houston, Houston, TX, United States; Mohamed Badawy, University of Texas Southwestern Medical School, Dallas, TX, United States; Kevan A. McCarten-Gibbs, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Kenneth Yen, UT Southwestern: The University of Texas Southwestern Medical Center, Dallas, TX, United States; Paul Ishimine, University of California, San Diego School of Medicine, San Diego, CA, United States; Nisa atigapramoj, UCSF Benioff Children's Hospital Oakland, San Francisco, CA, United States; Pradip P.. Chaudhari, Children's Hospital Los Angeles, Los Angeles, CA, United States; Nathan Kuppermann, UC Davis School of Medicine, Sacrametno, CA, United States; James Holmes, University of California, Davis, School of Medicine, Sacramento, CA, United States
Associate Professor McGovern Medical School at UTHealth Houston Houston, Texas, United States
Background: Pediatric emergency care research relies on a guardian's presence at the initial evaluation for the history and written informed consent. Single-center data reveal a high rate of guardian absence in children with blunt head trauma, while data in other types of pediatric trauma are limited. Objective: We sought to determine the frequency of guardian presence at the initial emergency department (ED) evaluation of children with blunt abdominal trauma. We aimed to identify the reasons for guardian absence and contrast those with and without guardian presence. Design/Methods: This was a prospective observational cohort study of children (< 18 years) presenting to six Level 1 trauma centers after blunt abdominal trauma. Patient history and physical examination findings were documented by ED clinicians on structured forms after the initial evaluation. Data collected included guardian presence during the initial ED evaluation. When the guardian was absent, the reasons were recorded. Data were compared with Chi-squared or Wilcoxon rank-sum tests. Results: We enrolled 2,380 children of whom 2,362 (99.2%, 95% confidence interval [CI] 98.8, 99.6%) had data on guardian presence. Median age was 9.6 years (IQR 5.2, 13.7). Guardians were absent in 764 (32%, 95% CI 30,34%). Reasons for guardian absence were (could be multiple): guardian not in the ambulance (250, 33%), guardian location unknown (160, 21%), guardian also involved in the trauma and being treated at the same ED (135, 18%) or different ED (106, 14%), child brought in by a non-guardian (80, 10%), guardian involved in traumatic event and en route (36, 5%), guardian died in the event (17, 2%) and other/unknown (53, 7%). Patients with guardian absence were more likely to be older (11.8 years, IQR 6.4, 14.8 vs 8.7 years, IQR 4.7, 13.1 years, p< 0.0001), have lower initial Glasgow Coma Scale scores (15, IQR 14, 15 vs 15, IQR 15, 15, p< 0.0001), and have intra-abdominal injuries (12.4% [95% CI 10.2,15.0%] vs 4.3%, [95% 3.4, 5.4%] p< 0.001).
Conclusion(s): Nearly a third of children with blunt abdominal trauma did not have a guardian present at their initial ED evaluation. Patients whose guardians were absent were older and more severely injured. Pediatric trauma research requiring guardian informed consent at the initial ED evaluation could be limited by selection bias and therefore not be representative.